GP to refuse 'costly' patients: Leading fund-holder says more money needed to take on mentally handicapped people. Nicholas Timmins reports

ONE OF THE foremost advocates of GP fund-holding has told his health authority that he will refuse to take on any more mentally handicapped patients transferred from long-stay hospitals unless extra funds are provided.

Dr David Tod - President of the National Association of Fundholding Practices, who spoke at the Tory party conference on Thursday on the virtues of fund- holding as vice-president of the Conservative Medical Society - has warned that unless he and his partners have adequate funding for mentally handicapped people 'we will be unable to accept any more . . . on to our list'.

The south London practice's 'purchasing intentions' document for next year says Dr Tod and his partners have already accepted some people with learning disabilities, transferred from Surrey's long-stay mental handicap hospitals to community homes in Wandsworth, south London.

'The financial risk to us in accepting these patients is great,' the document says. Without adequate funding, 'we will be unable to accept any more such people'.

David Blunkett, Labour's health spokesman, said yesterday: 'This illustrates exactly what we said would happen with fund-holding where GPs' have fixed budgets - that they would refuse to take on expensive patients.'

Dr Tod initially said yesterday: 'We certainly cannot accept any more because we are overloaded at the moment.' His practice of 15,000 patients had already taken on between 10 and 20 mentally handicapped people. 'There is no other general practice in our area, whether fund-holding or not, that has our load of people with learning disabilities.'

Asked if this was not an example of fund-holders selecting out costly patients, Dr Tod said that was not the intention and the document's phrasing, agreed with his partners, was 'a bald statement' that he would wish to qualify.

'If they don't increase our budget to take into account our current allocation, we would find it very difficult to take more on - that is not to say we wouldn't.

'I think when it comes to Mrs Smith's handicapped son, we would accept him and then argue about the funding afterwards.' But the practice did want to discuss the issue with the Family Health Services Authority and the regional health authority that provides its funds.

Asked what would happen if his practice refused to take any more transferred patients, Dr Tod said, 'we are not saying we would' but added 'there is plenty of choice - we are surrounded by doctors', although his was the only fund-holding practice in the area.

Mr Blunkett said: 'It is entirely wrong that practices should discriminate against people with learning disabilities. Fund-holding has already created two tiers of patients and Dr Tod seems set to create more.'